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Fast action: New stroke treatment allows for good chance of recovery

Copyright © 2016 Albuquerque Journal

Patricia Antich showed all the classic symptoms of stroke after she collapsed in her

Santa Fe home last month. She was partially paralyzed, unable to walk, with little use of her left arm and drooping facial features.

About seven hours later, a physician at University of New Mexico Hospital used a specialized stent to reach deep into Antich’s brain and remove a blood clot from her middle cerebral artery, restoring blood flow in time to prevent major damage.

The new technique is good news for New Mexico, because it gives doctors up to eight hours to treat clot-caused ischemic strokes, providing time to transport patients from even distant corners of the state.

The procedure uses a stent called a stent retriever, or “stentriever,” that allows doctors to grab a clot and remove it. The special stent, which resembles a tiny wire cage, is inserted through a catheter into a blood vessel in the groin, then steered into the brain using powerful imaging technology such as MRI.

“The new technology has just changed the game,” said Dr. Howard Yonas, chairman of the UNM Department of Neurosurgery.

The stent retriever marks a major advance over previous devices that were marginally effective at removing large clots from major arteries in the brain, Yonas said.

A 3mm-long blood clot contained within a stent retriever, or "stentriever." The device helped a University of New Mexico physician to remove the clot from a large artery in Patricia Antich's brain just hours after she suffered a stroke earlier this month.

A 3mm-long blood clot contained within a stent retriever, or “stentriever.” The device helped a University of New Mexico physician to remove the clot from a large artery in Patricia Antich’s brain just hours after she suffered a stroke earlier this month.

“It’s unbelievable,” Yonas said. “We’re getting these clots out within 20 minutes of sticking a needle into the groin. It used to take us hours and hours, monkeying around with different catheters.”

UNMH is the only hospital in New Mexico that offers the procedure, he said.

In Antich’s case, Dr. Danielle Eckart Sorte, a UNMH neuroradiologist, began the procedure about 1 a.m. May 18, about seven hours after the 85-year-old Santa Fe woman collapsed in her home.

The procedure is usually most effective if performed within six hours.

“We can, in selected cases, with advanced imaging such as MRI, perform stroke procedures after the six-hour window,” said Sorte, 37, an Albuquerque native and 2007 graduate of UNM’s School of Medicine.

Within 20 minutes, Sorte guided the catheter and removed the 3mm-long clot. Sorte first used an “aspiration catheter” that vacuums up small clots, then deployed a stent retriever to remove the main clot.

Sorte joined the UNMH staff in October after receiving advanced training at Johns Hopkins Hospital in Baltimore. She has since performed at least 22 clot-removing procedures here. Sorte is one of three UNM physicians who are on call 24/7 to perform the procedure.

The day after her stroke, Antich was able to speak and use her left arm normally, said Elizabeth Allen, who found Antich collapsed in a bathroom.

“I was just amazed when I saw her the next morning – it was like a miracle,” Allen said in Antich’s room at UNMH.

A personal health assistant, Allen has seen the devastating consequences of stroke, which can include permanent paralysis, loss of speech, and death.

“I’ve seen the other side of strokes, when it took months and months, and they never really recover,” she said.

Stroke is the fifth-leading cause of death and the leading cause of adult disability in New Mexico and the U.S. Strokes killed 679 New Mexicans in 2013.

The new technique – called thrombectomy – allows doctors to reverse the devastating effects of a stroke, ideally within six hours, Yonas said. The six-hour window is important because air and ground medical transport can get most New Mexico stroke patients to Albuquerque within that time, he said.

An older, standard treatment for ischemic strokes is a drug called tPA, or tissue plasminogen activator, often called the “clot-busting drug” because of its ability to dissolve clots. Since its FDA approval in 1996, tPA has been used to treat some 800,000 ischemic strokes a year nationwide.

But tPA treatment has limitations, Yonas said. The drug is most effective if used in the first three or four hours, and it has little effect on large clots in big arteries, he said.

“The tPA just doesn’t touch those big clots,” he said. “You still have a large, devastating stroke.”